Questions About Whether the Pitcher Can Really Avoid Surgery and Play Again This Season

The most important right arm in New York remains far away from a pitcher's mound. And even though the Yankees have announced a six-week timetable for Masahiro Tanaka's return, the news that he will attempt to avoid reconstructive surgery on his elbow has left both Tanaka and the Yankees in limbo.

Can Tanaka really avoid surgery and pitch again this season? Can the Yankees survive without him? How should his absence affect what they do at the trade deadline?

Tanaka has yet to meet with the media, but he issued a statement Friday in which he apologized for not being able to pitch.

"I want to apologize to the Yankees organization, my teammates and our fans for not being able to help during this time," he said. "I accept this injury as a challenge, but I promise to do everything I can to overcome this setback and return to the mound as soon as possible."

Meanwhile, the Yankees acquired starter Jeff Francis in a trade to help shore up their decimated rotation.
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How realistic is that?

Both Yankee brass and players have been relentlessly optimistic since learning that Tanaka had a partial tear of the ulnar collateral ligament, with an accompanying recommendation against Tommy John ligament repair surgery. They say they expect the 25-year-old rookie to return this season, and that he will be as good or nearly as good when he does.

Tanaka will receive an injection of platelet-rich plasma in an attempt to repair the area, and Yankee general manager Brian Cashman said his team of doctors told him there's a chance that the ligament could heal if the treatment goes well.

"Depending on the circumstances and the size of the tear, ligaments can repair themselves," Cashman said. "They've had success with it and we've personally experienced that."

Other doctors are more skeptical. Dr. Michael Hausman, chief of hand and elbow surgery and interim chair of the Department of Orthopaedics at the Icahn School of Medicine at Mount Sinai, said the success of the plasma therapy is a long shot.

"There are anecdotal reports of success, but the evidence actually substantiating its efficacy is pretty slim," he said. "If the patient strongly requests it, I will do it but I caution the patient that in my experience it doesn't actually solve the problem."

Even if it does work, and Tanaka feels better by August, he won't be wholly sound. His body will attempt to heal the area, plastering over it with scar tissue, but the ligament will never actually regrow, and without surgery the remaining tissue will be weaker, and always at risk for a full rupture.

"In low-demand situations, its strength might be adequate; when you're talking about someone like Tanaka, I think having a partial tear is akin to being just a tad pregnant," Hausman said.

That reflects the experience of Mets ace Matt Harvey, who suffered a partial tear of his ulnar collateral ligament last season and tried the rehab route before agreeing to undergo Tommy John surgery. When he heard about Tanaka, Harvey said he could relate. He, too, had wanted to avoid surgery, but realized the ligament could blow out completely at any time.

"At first I felt I could battle through it, but after waking up every morning for weeks, wondering when it was going to completely go on me…at that point I had had enough and went and had the surgery," Harvey said. "It was just something I could feel would be in the back of my mind the whole time and I didn't want to deal with that."

Of course, every tear is different, and Cashman emphasized that Tanaka's tear is very small. Some pitchers, like the Cardinals' Adam Wainwright, have pitched through a partial tear with great success; Wainwright did so for roughly six years, finishing in the top three in Cy Young voting twice along the way.

That's certainly the best-case scenario for the Yankees, who actually seemed upbeat upon hearing the diagnosis of Tanaka's partial tear. When Tanaka initially left the team, most of his teammates assumed the worst, said reliever Shawn Kelley, who has twice undergone Tommy John surgery.

"If what they say happens, and it's six weeks, I think that's a win," Kelley said. "Whenever you hear elbow, you think Tommy John."

But even if Tanaka can make a triumphant return in late August, will there be anything left for him to save?

The Yankees are 13-5 this season when Tanaka takes the mound and 31-40 when he doesn't. The rest of the starting rotation is shredded, as Hiroki Kuroda is the only healthy starter left from the Yankees' opening-day rotation. The bullpen has been overworked. And the offense has been toothless. There is little reason to believe the Tanaka-less Yankees, as presently constituted, can remain in the race until his return.

That leaves the Yankees in an odd position, where every July series is crucial. Their fortunes over the next few weeks will determine whether they should be buyers or sellers at the July 31 trade deadline.

At the moment, the Yankees are still firmly in buying mode. On Friday, Cashman made a trade for Oakland lefty Jeff Francis to help fill some of the pitching void, and he vowed he is trying to make bigger moves.

"We have been aggressive and we will continue to be aggressive unless I'm told otherwise," Cashman said. "We are in the middle of a division fight and we want to stay in the fight, so we'll continue to look at any opportunities and options that present themselves to upgrade."

So the Yankees will plan as if Tanaka is returning in top form, even if there is scant evidence that it will occur. Tanaka needs to trust his elbow to be truly elite, Hausman cautioned, and that kind of recovery is going to be tough to realize.

"Someone like him really requires the last half percent of top performance, and I think that's going to be hard for him to achieve with any regularity, if at all," Hausman said, pausing. "But I hope I'm wrong."